Provider Demographics
NPI:1285097659
Name:PANDOLFI COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:PANDOLFI COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CONNIE
Authorized Official - Last Name:PANDOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-479-3158
Mailing Address - Street 1:1001 CITY AVE UNIT WA804
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3939
Mailing Address - Country:US
Mailing Address - Phone:305-479-3158
Mailing Address - Fax:
Practice Address - Street 1:1001 CITY AVE UNIT WA804
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3939
Practice Address - Country:US
Practice Address - Phone:646-981-7059
Practice Address - Fax:610-206-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIO402ZOtherMEDICARE PTAN
FL018344400Medicaid
FLIO402ZOtherMEDICARE PTAN GRP